Massimiliano Visocchi1, Francesco Signorelli2, Chenlong Liao3, Mario Rigante4, Gaetano Paludetti4, Giuseppe Barbagallo5, Alessandro Olivi1. 1. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy. 2. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy. Electronic address: francesco.signorelli1984@gmail.com. 3. Department of Neurosurgery, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. 4. Institute of Otolaryngology, Catholic University of Rome, Rome, Italy. 5. Division of Neurosurgery, Department of Neurosciences, Policlinico "G.Rodolico" University Hospital, Catania, Italy.
Abstract
OBJECTIVE: For many years, the microsurgical transoral approach has been accepted as the gold standard for anterior decompressions of the craniovertebral junction (CVJ). The introduction of the endoscopic endonasal approach (EEA) has gained wide recognition and overwhelming support in recent years, including for diseases of the CVJ. The aim of this study was to critically analyze and discuss all cases of CVJ diseases approached by means of an EEA so far reported in the literature, including our institutional experience consisting of 6 consecutive patients. METHODS: Six consecutive patients affected by CVJ disease underwent an EEA. Three patients had a tumor (2 chordomas and 1 myeloma) and 3 had impressio basilaris. RESULTS: Five patients had an uncomplicated postoperative course and 1 developed an intraoperative cerebrospinal fluid leak and subsequent meningitis and died 5 weeks after surgery. A total of 107 patients (including our 6) affected by CVJ disease and treated with EEA have been reported so far. Among these patients, cerebrospinal fluid leak was reported in 13 (12.4%), transient velopharyngeal incompetence in 6 (5.6%), postoperative epistaxis in 2 (1.86%), and respiratory dysfunction requiring a tracheostomy in 2 (1.86%). In our extended institutional series of more than 20 consecutive anterior decompressions for CVJ diseases (including transoral and transnasal microsurgical approaches), the only fatal complication was associated with EEA. CONCLUSIONS: On the basis of the reviewed literature and our personal experience, the reported increased safety of the EEA needs to be reassessed and discussed.
OBJECTIVE: For many years, the microsurgical transoral approach has been accepted as the gold standard for anterior decompressions of the craniovertebral junction (CVJ). The introduction of the endoscopic endonasal approach (EEA) has gained wide recognition and overwhelming support in recent years, including for diseases of the CVJ. The aim of this study was to critically analyze and discuss all cases of CVJ diseases approached by means of an EEA so far reported in the literature, including our institutional experience consisting of 6 consecutive patients. METHODS: Six consecutive patients affected by CVJ disease underwent an EEA. Three patients had a tumor (2 chordomas and 1 myeloma) and 3 had impressio basilaris. RESULTS: Five patients had an uncomplicated postoperative course and 1 developed an intraoperative cerebrospinal fluid leak and subsequent meningitis and died 5 weeks after surgery. A total of 107 patients (including our 6) affected by CVJ disease and treated with EEA have been reported so far. Among these patients, cerebrospinal fluid leak was reported in 13 (12.4%), transient velopharyngeal incompetence in 6 (5.6%), postoperative epistaxis in 2 (1.86%), and respiratory dysfunction requiring a tracheostomy in 2 (1.86%). In our extended institutional series of more than 20 consecutive anterior decompressions for CVJ diseases (including transoral and transnasal microsurgical approaches), the only fatal complication was associated with EEA. CONCLUSIONS: On the basis of the reviewed literature and our personal experience, the reported increased safety of the EEA needs to be reassessed and discussed.
Authors: Olga M Sergeenko; Konstantin A Dyachkov; Sergey O Ryabykh; Alexander V Burtsev; Alexander V Gubin Journal: Childs Nerv Syst Date: 2019-11-03 Impact factor: 1.475
Authors: Francesco Maiuri; Luigi Maria Cavallo; Sergio Corvino; Giuseppe Teodonno; Giuseppe Mariniello Journal: J Craniovertebr Junction Spine Date: 2020-11-26